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,MULTIPLE CHOICES
1. A 45-year-old female presents with a firm, non-tender mass in the upper outer quadrant of her right
breast that is fixed to the underlying tissue. Which of the following is the most appropriate next step?
A) Reassure the patient and schedule a routine mammogram in one year
B) Order a diagnostic mammogram and ultrasound
C) Prescribe oral antibiotics for suspected mastitis
D) Perform fine-needle aspiration in the office
Answer: B
Rationale: A firm, fixed, non-tender mass in the upper outer quadrant is suspicious for breast malignancy;
diagnostic imaging with mammogram and ultrasound is the appropriate next step to evaluate the lesion.
2. During palpation of the thyroid gland, which of the following physical exam findings is most
concerning and should prompt further evaluation?
A) A palpable isthmus that moves with swallowing
B) A firm, 2.5 cm nodule in the right lobe
C) A smooth, symmetrical gland that is non-tender
D) A barely palpable pyramidal lobe
Answer: B
Rationale: A firm, palpable nodule in the thyroid requires further evaluation with ultrasound and possible
fine-needle aspiration to rule out malignancy; normal thyroid is smooth and symmetrical.
3. A 72-year-old male presents with a history of smoking and reports a chronic cough with hemoptysis.
Which of the following findings on examination is a red flag requiring immediate investigation?
A) Decreased breath sounds at the left base
B) A palpable supraclavicular lymph node
C) Mild clubbing of the fingers
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,D) Increased anteroposterior chest diameter
Answer: B
Rationale: A palpable supraclavicular (Virchow's) lymph node in a patient with respiratory symptoms is
highly suspicious for metastatic malignancy and requires urgent investigation.
4. A 28-year-old female presents with acute onset of severe right lower quadrant abdominal pain, nausea,
and vomiting. Her temperature is 100.8°F. Which of the following examination findings is most
consistent with appendicitis?
A) Rebound tenderness at McBurney's point
B) Diffuse abdominal tenderness with guarding
C) Positive Murphy's sign
D) Costovertebral angle tenderness
Answer: A
Rationale: Rebound tenderness at McBurney's point (located two-thirds of the distance from the
umbilicus to the right anterior superior iliac spine) is a classic sign of appendicitis.
5. A 55-year-old male with a history of hypertension presents for a routine physical examination. Which
of the following findings on fundoscopic examination is most consistent with chronic hypertension?
A) Papilledema with blurred disc margins
B) Arteriovenous nicking and copper-wiring of arteries
C) Optic atrophy with pallor of the disc
D) Cotton-wool spots with hemorrhages
Answer: B
Rationale: Arteriovenous nicking and copper-wiring of retinal arteries are characteristic findings of
chronic hypertensive retinopathy due to long-standing elevated blood pressure.
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, 6. During the abdominal examination, which of the following sequences is correct to minimize alteration
of bowel sounds?
A) Inspection → Palpation → Percussion → Auscultation
B) Inspection → Auscultation → Percussion → Palpation
C) Palpation → Percussion → Auscultation → Inspection
D) Auscultation → Inspection → Palpation → Percussion
Answer: B
Rationale: The correct abdominal examination sequence is Inspection, then Auscultation, then Percussion,
then Palpation (I-A-P-P) to prevent altering bowel sounds with palpation.
7. A 34-year-old pregnant female at 28 weeks gestation presents with a blood pressure of 148/92 mm Hg
and 2+ proteinuria. Which of the following findings on examination is most concerning for preeclampsia?
A) Fundal height of 28 cm
B) Hyperreflexia with clonus
C) Fetal heart rate of 140/min
D) Mild dependent edema
Answer: B
Rationale: Hyperreflexia with clonus indicates central nervous system irritability and is a sign of severe
preeclampsia, which can progress to eclampsia with seizures.
8. A 62-year-old male presents with a history of heavy alcohol use and reports abdominal distension. On
examination, you note shifting dullness on abdominal percussion. Which of the following is the most
likely diagnosis?
A) Cirrhosis with ascites
B) Gastric outlet obstruction
C) Small bowel obstruction
Page 4 of 207
,MULTIPLE CHOICES
1. A 45-year-old female presents with a firm, non-tender mass in the upper outer quadrant of her right
breast that is fixed to the underlying tissue. Which of the following is the most appropriate next step?
A) Reassure the patient and schedule a routine mammogram in one year
B) Order a diagnostic mammogram and ultrasound
C) Prescribe oral antibiotics for suspected mastitis
D) Perform fine-needle aspiration in the office
Answer: B
Rationale: A firm, fixed, non-tender mass in the upper outer quadrant is suspicious for breast malignancy;
diagnostic imaging with mammogram and ultrasound is the appropriate next step to evaluate the lesion.
2. During palpation of the thyroid gland, which of the following physical exam findings is most
concerning and should prompt further evaluation?
A) A palpable isthmus that moves with swallowing
B) A firm, 2.5 cm nodule in the right lobe
C) A smooth, symmetrical gland that is non-tender
D) A barely palpable pyramidal lobe
Answer: B
Rationale: A firm, palpable nodule in the thyroid requires further evaluation with ultrasound and possible
fine-needle aspiration to rule out malignancy; normal thyroid is smooth and symmetrical.
3. A 72-year-old male presents with a history of smoking and reports a chronic cough with hemoptysis.
Which of the following findings on examination is a red flag requiring immediate investigation?
A) Decreased breath sounds at the left base
B) A palpable supraclavicular lymph node
C) Mild clubbing of the fingers
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,D) Increased anteroposterior chest diameter
Answer: B
Rationale: A palpable supraclavicular (Virchow's) lymph node in a patient with respiratory symptoms is
highly suspicious for metastatic malignancy and requires urgent investigation.
4. A 28-year-old female presents with acute onset of severe right lower quadrant abdominal pain, nausea,
and vomiting. Her temperature is 100.8°F. Which of the following examination findings is most
consistent with appendicitis?
A) Rebound tenderness at McBurney's point
B) Diffuse abdominal tenderness with guarding
C) Positive Murphy's sign
D) Costovertebral angle tenderness
Answer: A
Rationale: Rebound tenderness at McBurney's point (located two-thirds of the distance from the
umbilicus to the right anterior superior iliac spine) is a classic sign of appendicitis.
5. A 55-year-old male with a history of hypertension presents for a routine physical examination. Which
of the following findings on fundoscopic examination is most consistent with chronic hypertension?
A) Papilledema with blurred disc margins
B) Arteriovenous nicking and copper-wiring of arteries
C) Optic atrophy with pallor of the disc
D) Cotton-wool spots with hemorrhages
Answer: B
Rationale: Arteriovenous nicking and copper-wiring of retinal arteries are characteristic findings of
chronic hypertensive retinopathy due to long-standing elevated blood pressure.
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, 6. During the abdominal examination, which of the following sequences is correct to minimize alteration
of bowel sounds?
A) Inspection → Palpation → Percussion → Auscultation
B) Inspection → Auscultation → Percussion → Palpation
C) Palpation → Percussion → Auscultation → Inspection
D) Auscultation → Inspection → Palpation → Percussion
Answer: B
Rationale: The correct abdominal examination sequence is Inspection, then Auscultation, then Percussion,
then Palpation (I-A-P-P) to prevent altering bowel sounds with palpation.
7. A 34-year-old pregnant female at 28 weeks gestation presents with a blood pressure of 148/92 mm Hg
and 2+ proteinuria. Which of the following findings on examination is most concerning for preeclampsia?
A) Fundal height of 28 cm
B) Hyperreflexia with clonus
C) Fetal heart rate of 140/min
D) Mild dependent edema
Answer: B
Rationale: Hyperreflexia with clonus indicates central nervous system irritability and is a sign of severe
preeclampsia, which can progress to eclampsia with seizures.
8. A 62-year-old male presents with a history of heavy alcohol use and reports abdominal distension. On
examination, you note shifting dullness on abdominal percussion. Which of the following is the most
likely diagnosis?
A) Cirrhosis with ascites
B) Gastric outlet obstruction
C) Small bowel obstruction
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